Medical Ultrasound – The Future Is Here!

Tuesday the 30th of June 2020 marked a very special day in Tweed Podiatry’s history. The day we officially launched our new medical ultrasound service and became the first Podiatry clinic (private or NHS) to offer this advanced technology in the Scottish Borders.

As someone experienced in using ultrasound both in the UK and overseas, I’ve seen first-hand the potential this technology has to enhance the care of patients with all manner of foot and ankle problems. I am incredibly excited and proud to bring this service to the Scottish Borders and cannot wait to see how it changes the game for our practice and the people we serve. So without further ado, let me introduce you to the future!

The Highlights

Fair warning, I couldn’t not geek out on writing this piece, it’s just too exciting! So if you don’t have time for the finer details, here’s some of the key takeaways:

- We have built the first Podiatric medical ultrasound service in the Scottish Borders’ history.

- The technology is safe, rapid to access and can provide hugely helpful information in diagnosing problems in all sorts of tissues including muscles, joints, ligaments, bones, nerves and blood vessels. You and the Podiatrist can view the images and video in real-time.

- It can also allow for targeted therapies such as joint injections and anaesthetic procedures making them far safer and easier than without this technology.

- You can access this service with us via referral from your doctor or other health professional or you can self-refer to have an assessment with our team using our contact form, email or phone number where we will be only too happy to help.

First off, what is ultrasound?

Medical Ultrasound has it’s roots in marine sonar technology and was first developed for clinical applications by Glasgow Professor Ian Donald and Dr John McVicar. Most of us will picture an obstetrics clinic (childbirth and midwifery) when we think of ultrasound and this is indeed an enormous area of its use. But over the years with advancements in technology, cost and portability it has grown to cover more than a quarter of ALL imaging requests in the UK and includes a wide variety of applications in almost every field of medicine including finding its way into the hands of advanced practitioners in Sports Medicine, Physiotherapy and Podiatry (including us!)

The physics of how medical ultrasound works can quickly get very complex (as my own training has definitely taught me!) but in a nutshell: Pulsed sound waves (several million a second!) are emitted from a transducer into the body - different things will then happen to the sound waves depending on what body tissues they interact with, some passing through, some deflecting off, others bouncing back to the transducer as echoes. The returning echoes (or the lack of them) are received and then processed by the ultrasound machine and used to construct an on-screen image that represents what’s going on inside.

(As a quick side-note, this is not to be confused with so-called “therapeutic” ultrasound – those small units with no screen that are applied to the skin to generate heat – completely different)

Is it safe?

In a word, YES. Medical Ultrasound of the foot and ankle is extremely safe. It involves no ionising radiation (like that used in X-rays and CT scans) and carries no other health risks.

What sort of stuff can ultrasound see?

Ultrasound is incredibly versatile and can produce images of all manner of stuff including muscles, joints, ligaments, bones, nerves and blood vessels. It lends itself particularly well to foot and ankle scanning as most structures aren’t that deep PLUS unlike other image options it is dynamic (we can assess structures whilst in motion). Some examples include:

Painful big toe joint? We can assess things like swelling and thickening of the joint, even pick up on inflammation in the former of increased blood flow in tiny vessels.

Heel pain? We can assess the health of tissues like your plantar fascia to help inform a rehab. plan and look at associated structures like fat tissue, muscles and even individual nerves that might be involved.

Nerve issues? The detail of our machine is so great it can be use visualise even small peripheral nerves and assess them for damage, swelling and inflammation.

Achilles pain? We can find out what stage of the process the achilles tendon is in and even consider using ultrasound for guided therapies like high-volume injection therapy (a pioneering technique I’ll be writing more about soon!)

This list could go on for days but in short, ultrasound is a very powerful tool for supporting (and sometimes changing) a clinical diagnosis and can remove a lot of guess work, help grade the severity of an injury, open the door to therapies otherwise unachievable or simply educate and reassure someone that nothing serious is taking place.

Say Hello to Hedwig!

A warm welcome to our new team member - the Esaote MyLab Omega or as she’s been nicknamed, Hedwig. We’ve spent an extraordinarily long time trialling multiple machines as many of you will have spotted over the past 2 years on our social media. The slow process was very deliberate – the choice had to be right and after a lot of homework and experimenting, the awesome people at Esaote introduced a machine that has quite honestly blown all competitors in her class out of the water. She appeals to all my geeky tendencies with a huge repertoire of technologies built it in, incredible image quality and the fanciest looking machine out there (Italian design so no surprises there!).

Why Pick Tweed Podiatry for Ultrasound?

Outside our clinic there are essentially two other options which we’ll aim to described and explain what makes us different. The first is to be referred for an ultrasound scan with an NHS ultrasound provider (usually a Sonographer, Radiographer or Radiologist). The main downside of this option (in our opinion) is that scan waiting times can often be very long (in excess of 10 weeks isn’t unusual) and are not necessarily performed by someone with a great deal of specific background in foot and ankle problems that your Podiatrist would have.

The other option would be ultrasound with a practitioner in a private hospital setting. We know radiologists who work in this field and can vouch for the quality of work being excellent and much more quickly accessed (we have regularly taken this path with our patients needing imaging services) but the downside here being often very high costs involved.

We’re confident we’ve solved all these problems at once; very short waiting times, scans at a fraction of the costs elsewhere and a scan performed by a Podiatrist who will know your background and the nature of your problem as well as having in-depth knowledge, skills and training that focusses specifically towards foot and ankle scanning.

Who Will Scan My Foot?

Our practice owner, Robert McCririck (the guy with the 70s do’ above), is responsible for all ultrasound services at the practice. He has several years’ experience of scanning in various clinical settings which has most recently involved an intensive 18+ months of the CASE-accredited Post-Graduate Certificate in Medical Ultrasound at Glasgow Caledonian University. He has since been invited to guest lecture on the role of ultrasound in Podiatric Sports Medicine and is also running a number of upcoming seminars for fellow health professionals in the Scottish Borders and beyond.

How do I learn more or get an appointment?

You can access this service with us via referral from your doctor or any other health professional. You can also self-refer to have a consultation with our team using our contact form, email or phone number.

There will also be plenty more content about medical ultrasound on the way but in the meantime, any questions, please don’t hesitate to get in touch. We are so thrilled about what this will mean for our team, our patients and our community – better diagnosing, better care, healthier and happier people! The future looks bright and we look forward to being there with you, every step of the way.